胸段食管鳞癌根治术后复发特征的研究-现代医学

胸段食管鳞癌根治术后复发特征的研究

单位：兴化市第三人民医院肿瘤科, 江苏兴化 225700

分类号：R735.1

出版年·卷·期（页码）：2018·46·第八期（876-880）

摘要：

目的：研究胸段食管鳞癌根治术后局部复发特征，探讨术后放疗靶区的勾画。方法：分析98例胸段食管鳞癌根治术后复发患者，对各部位复发率进行研究，预测复发部位，确定CTV勾画方案。结果：98例患者主要表现为区域淋巴结复发，依次为2区52例（53.1%）、1区29例（29.6%）、4区25例（25.5%），右锁骨上区23例（23.5%）。食管胸中段右锁骨上区复发率大于左锁骨上区（χ²=5.124，P=0.024），差异显著。食管胸下段术后淋巴结阳性者较胸上、中段癌术后、胸下段术后淋巴结阴性者腹腔淋巴转移率增加。吻合口复发10例，占10.2%，瘤床复发2例，占2%。单因素分析显示分化程度、PN、PGTNM分期与局部复发有统计学差异，多因素COX回归分析显示PN是局部复发的独立危险因素。结论：上纵隔及右锁骨上区是食管鳞癌根治术后局部复发的重点部位。

Objective:To study the local recurrence feature of thoracic esophageal squamous cell carcinoma(ESCC)after radical resection, discuss the target region of postoperative radiotherapy. Methods:The recurrence rate of patients with thoracic esophageal squamous cell carcinomaafter radical resection was studied,the recurrence site was predicted and the CTV (clinical target volume) plan was determined. Results:The main manifestation of 98 patients was regional lymph node recurrence, followed by, 52 cases (53.1%) in areas 2, 29 cases (29.6%) in cases 1, 25 cases (25.5%) in cases4, and 23 cases (23) in right supraclavicular region. The recurrence rate of the right supraclavicular area in the middle thoracic segment of esophagus was higher than that in the left supraclavicular area (χ²=5.124), and the difference was significant. The positive rate of lymph nodes in the lower thoracic segment of esophagus was higher than that in the upper and middle segment of esophagus, and the rate of lymphatic metastasis was higher in the patients with negative lymph nodes in the lower thoracic segment of esophagus. There were 10 cases of anastomotic recurrence (10.2%) and 2 cases of tumor recurrence (2 cases). Univariate analysis showed that there was a significant difference between PNN and PGTNM staging and local recurrence.Multivariate COX regression model Analysis only showed PN was an independent risk factor for local recurrence.Conclusion:The superior mediastinum and right supraclavicular area are the key sites for local recurrence of esophageal squamous cell carcinoma after radical resection.

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